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Consenso Colombiano para la prevención, diagnóstico y manejo de condiciones trombóticas en pacientes adultos con COVID-19: aplicando el Marco de la Evidencia a la Decisión (EtD) GRADE
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Acevedo-Peña, Juan
; Yomayusa-González, Nancy
; Cantor-Cruz, Francy
; Pinzon-Florez, Carlos
; Barrero-Garzón, Liliana
; De-La-Hoz-Siegler, Ilich
; Low-Padilla, Eduardo
; Ramírez-Ceron, Carlos
; Combariza-Vallejo, Felipe
; Arias-Barrera, Carlos
; Moreno-Cortés, Javier
; Rozo-Vanstrahlen, José
; Correa-Pérez, Liliana
; Rojas-Gambasica, José
; González-González, Camilo
; La-Rotta-Caballero, Eduardo
; Ruíz-Talero, Paula
; Contreras-Páez, Rubén
; Lineros-Montañez, Alberto
; Ordoñez-Cardales, Jorge
; Escobar-Olaya, Mario
; Izaguirre-Ávila, Raúl
; Campos-Guerra, Joao
; Accini-Mendoza, José
; Pizarro-Gómez, Camilo
; Patiño-Pérez, Adulkarín
; Flores-Rodríguez, Janine
; Valencia-Moreno, Albert
; Londoño-Villegas, Alejandro
; Saavedra-Rodríguez, Alfredo
; Madera-Rojas, Ana
; Caballero-Arteaga, Andrés
; Díaz-Campos, Andrés
; Correa-Rivera, Felipe
; Mantilla-Reinaud, Andrés
; Becerra-Torres, Ángela
; Peña-Castellanos, Ángela
; Reina-Soler, Aura
; Escobar-Suarez, Bibiana
; Patiño-Escobar, Bonell
; Rodríguez-Cortés, Camilo
; Rebolledo-Maldonado, Carlos
; Ocampo-Botero, Carlos
; Rivera-Ordoñez, Carlos
; Saavedra-Trujillo, Carlos
; Figueroa-Restrepo, Catalina
; Agudelo-López, Claudia
; Jaramillo-Villegas, Claudia
; Villaquirán-Torres, Claudio
; Rodríguez-Ariza, Daniel
; Rincón-Valenzuela, David
; Lemus-Rojas, Melissa
; Pinto-Pinzón, Diego
; Garzón-Díaz, Diego
; Cubillos-Apolinar, Diego
; Beltrán-Linares, Edgar
; Kondo-Rodríguez, Emilio
; Yama-Mosquera, Erica
; Polania-Fierro, Ernesto
; Real-Urbina, Evalo
; Rosas-Romero, Andrés
; Mendoza-Beltrán, Fernán
; Guevara-Pulido, Fredy
; Celia-Márquez, Gina
; Ramos-Ramos, Gloria
; Prada-Martínez, Gonzalo
; León-Basantes, Guillermo
; Liévano-Sánchez, Guillermo
; Ortíz-Ruíz, Guillermo
; Barreto-García, Gustavo
; Ibagón-Nieto, Harold
; Idrobo-Quintero, Henry
; Martínez-Ramírez, Ingrid
; Solarte-Rodríguez, Ivan
; Quintero-Barrios, Jorge
; Arenas-Gamboa, Jaime
; Pérez-Cely, Jairo
; Castellanos-Parada, Jeffrey
; Garzón-Martínez, Fredy
; Luna-Ríos, Joaquín
; Lara-Terán, Joffre
; Vargas-Fodríguez, Johanna
; Dueñas-Villamil, Rubén
; Bohórquez-Feyes, Vicente
; Martínez-Acosta, Carlos
; Gómez-Mesa, Esteban
; Gaitán-Rozo, Julián
; Cortes-Colorado, Julián
; Coral-Casas, Juliana
; Horlandy-Gómez, Laura
; Bautista-Toloza, Leonardo
; Palacios Palacios, Leonardo
; Fajardo-Latorre, Lina
; Pino-Villarreal, Luis
; Rojas-Puentes, Leonardo
; Rodríguez-Sánchez, Patricia
; Herrera-Méndez, Mauricio
; Orozco-Levi, Mauricio
; Sosa-Briceño, Mónica
; Moreno-Ruíz, Nelson
; Sáenz-Morales, Oscar
; Amaya-González, Pablo
; Ramírez-García, Sergio
; Nieto-Estrada, Víctor
; Carballo-Zárate, Virgil
; Abello-Polo, Virginia
.
resumen está disponible en el texto completo
Abstract Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.
https://doi.org/10.36104/amc.2021.2078
253 downloads
2.
Consenso colombiano para la prevención, el diagnóstico y el tratamiento de condiciones trombóticas en adultos con COVID-19: aplicando el Marco de la Evidencia a la Decisión (EtD) GRADE
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Facebook Twitter
- Other social networks
- Google+
- StambleUpon
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- Mendeley
- Other networks
- Metrics
Acevedo-Peña, Juan
; Yomayusa-González, Nancy
; Cantor-Cruz, Francy
; Pinzón-Flórez, Carlos
; Barrero-Garzón, Liliana
; De-La-Hoz-Siegler, Ilich
; Low-Padilla, Eduardo
; Ramírez-Cerón, Carlos
; Combariza-Vallejo, Felipe
; Arias-Barrera, Carlos
; Moreno-Cortés, Javier
; Rozo-Vanstrahlen, José
; Correa-Pérez, Liliana
; Rojas-Gambasica, José
; González-González, Camilo
; La-Rotta-Caballero, Eduardo
; Ruíz-Talero, Paula
; Contreras-Páez, Rubén
; Lineros-Montañez, Alberto
; Ordoñez-Cardales, Jorge
; Escobar-Olaya, Mario
; Izaguirre-Ávila, Raúl
; Campos-Guerra, Joao
; Accini-Mendoza, José
; Pizarro-Gómez, Camilo
; Patiño-Pérez, Adulkarín
; Flores-Rodríguez, Janine
; Valencia-Moreno, Albert
; Londoño-Villegas, Alejandro
; Saavedra-Rodríguez, Alfredo
; Madera-Rojas, Ana
; Caballero-Arteagam, Andrés
; Díaz-Campos, Andrés
; Correa-Rivera, Felipe
; Mantilla-Reinaud, Andrés
; Becerra-Torres, Ángela
; Peña-Castellanos, Ángela
; Reina-Soler, Aura
; Escobar-Suarez, Bibiana
; Patiño-Escobar, Bonell
; Rodríguez-Cortés, Camilo
; Rebolledo-Maldonado, Carlos
; Ocampo-Botero, Carlos
; Rivera-Ordoñez, Carlos
; Saavedra-Trujillo, Carlos
; Figueroa-Restrepo, Catalina
; Agudelo-López, Claudia
; Jaramillo-Villegas, Claudia
; Villaquirán-Torres, Claudio
; Rodríguez-Ariza, Daniel
; Rincón-Valenzuela, David
; Lemus-Rojas, Melissa
; Pinto-Pinzón, Diego
; Garzón-Díaz, Diego
; Cubillos-Apolinar, Diego
; Beltrán-Linares, Edgar
; Kondo-Rodríguez, Emilio
; Yama-Mosquera, Erica
; Polania-Fierro, Ernesto
; Real-Urbina, Evalo
; Rosas-Romero, Andrés
; Mendoza-Beltrán, Fernán
; Guevara-Pulido, Fredy
; Celia-Márquez, Gina
; Ramos-Ramos, Gloria
; Prada-Martínez, Gonzalo
; León-Basantes, Guillermo
; Liévano-Sánchez, Guillermo
; Ortíz-Ruíz, Guillermo
; Barreto-García, Gustavo
; Ibagón-Nieto, Harold
; Idrobo-Quintero, Henry
; Martínez-Ramírez, Ingrid
; Solarte-Rodríguez, Ivan
; Quintero-Barrios, Jorge
; Arenas-Gamboa, Jaime
; Pérez-Cely, Jairo
; Castellanos-Parada, Jeffrey
; Garzón-Martínez, Fredy
; Luna-Ríos, Joaquín
; Lara-Terán, Joffre
; Vargas-Rodríguez, Johanna
; Dueñas-Villamil, Rubén
; Bohórquez-Reyes, Vicente
; Martínez-Acosta, Carlos
; Gómez-Mesa, Esteban
; Gaitán-Rozo, Julián
; Cortes-Colorado, Julián
; Coral-Casas, Juliana
; Horlandy-Gómez, Laura
; Bautista-Toloza, Leonardo
; Palacios, Leonardo Palacios
; Fajardo-Latorre, Lina
; Pino-Villarreal, Luis
; Rojas-Puentes, Leonardo
; Rodríguez-Sánchez, Patricia
; Herrera-Méndez, Mauricio
; Orozco-Levi, Mauricio
; Sosa-Briceño, Mónica
; Moreno-Ruíz, Nelson
; Sáenz-Morales, Oscar
; Amaya-González, Pablo
; Ramírez-García, Sergio
; Nieto-Estrada, Víctor
; Carballo-Zárate, Virgil
; Abello-Polo, Virginia
.
resumen está disponible en el texto completo
Abstract Introduction: recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. Objective: to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: a rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.
https://doi.org/10.1016/j.rccar.2020.08.003
86 downloads
3.
Acceso a los Servicios de Urgencias en Medellín, 2006
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Valencia- Sierra, Marta L.
; González-Echeverri, Germán
; Agudelo-Vanegas, Nelson A.
; Acevedo-Arenas, Liliana
; Vallejo-Zapata, Isabel C.
.
Objectives Describing access to and availability of emergency medical assistance in Medellín in 2006. Materials and Methods This was a descriptive survey-based study conducted in 27 emergency services from institutions providing tertiary, secondary and primary level health care services carried out over one full week. All patients participating in the survey were followed-up from being admitted to the emergency department to being discharged. The following parameters were described: a patient's characteristics, waiting time, presence of trauma, previous emergency department visit during the previous 48 hours for the same condition, transfer and discharge. The reasons for non-admission were studied in the case of patients who were not admitted by the emergency service. Results 8 703 (89,4 %) out of the 9 730 patients attending the emergency department were then admitted; 13,8 % had visited an emergency department during the previous 48 hours for the same condition and 10,5 % were early transfers. The highest mean waiting time observed for primary level was 40,2 minutes. Reasons for non-admission for the 1 027 non-admitted patients (10,6 %) included hospital staff classifying a case as not being an emergency (62,6 %) and lack of social security service coverage (16 %). Conclusions Barriers were found to emergency service access in Medellín. Inadequate access according to the type of emergency and its seriousness and deficient coordination of attention levels support the need for an emergency network in the city.
Objetivos Describir el acceso y la oportunidad de la atención de las urgencias médicas en Medellín, 2006. Materiales y Métodos Se realizó un estudio descriptivo en 27 servicios de urgencias de Instituciones Prestadoras de Servicios de Salud de tercero, segundo y primer nivel de atención durante una semana continua. A todas las personas admitidas se les realizó seguimiento hasta el egreso del servicio. Las siguientes variables fueron descritas: cacterísticas de persona, tiempos espera, presencia de trauma, consulta previa a un servicio de urgencias en las últimas 48 horas por la misma causa, referencia y egreso. En aquellas personas no admitidas se estudiaron las causas de no admisión. Resultados De 9 703 pacientes que visitaron los servicios de urgencias, 8 703 (89,4 %) fueron admitidos, 13,8 % habían consultado en las últimas 48 horas a un servicio de urgencias por la misma causa y el 10,5 % tuvieron remisión previa. Fue superior el tiempo espera en los servicios de urgencias de primer nivel (40,2 minutos). De las 1 027 (10,6 %) personas que no fueron admitidas, el 62,6 % fue debido a que la consulta no fue considerada urgente por el personal hospitalario, seguido del 16 % por no pertenecer a la red a la cual cotizaba. Conclusiones En los servicios de urgencias de Medellín existen barreras de acceso. El acceso inadecuado de acuerdo al tipo y gravedad de la urgencia y la deficiente la articulación de los niveles de atención, soporta la necesidad una red de urgencias en la ciudad.
3150 downloads
4.
Acceso a los Servicios de Urgencias en Medellín, 2006
Facebook Twitter
Facebook Twitter
- Other social networks
- Google+
- StambleUpon
- CiteULike
- Mendeley
- Other networks
- Metrics
Valencia- Sierra, Marta L.
; González-Echeverri, Germán
; Agudelo-Vanegas, Nelson A.
; Acevedo-Arenas, Liliana
; Vallejo-Zapata, Isabel C.
.
Objetivos Describir el acceso y la oportunidad de la atención de las urgencias médicas en Medellín, 2006. Materiales y Métodos Se realizó un estudio descriptivo en 27 servicios de urgencias de Instituciones Prestadoras de Servicios de Salud de tercero, segundo y primer nivel de atención durante una semana continua. A todas las personas admitidas se les realizó seguimiento hasta el egreso del servicio. Las siguientes variables fueron descritas: cacterísticas de persona, tiempos espera, presencia de trauma, consulta previa a un servicio de urgencias en las últimas 48 horas por la misma causa, referencia y egreso. En aquellas personas no admitidas se estudiaron las causas de no admisión. Resultados De 9 703 pacientes que visitaron los servicios de urgencias, 8 703 (89,4 %) fueron admitidos, 13,8 % habían consultado en las últimas 48 horas a un servicio de urgencias por la misma causa y el 10,5 % tuvieron remisión previa. Fue superior el tiempo espera en los servicios de urgencias de primer nivel (40,2 minutos). De las 1 027 (10,6 %) personas que no fueron admitidas, el 62,6 % fue debido a que la consulta no fue considerada urgente por el personal hospitalario, seguido del 16 % por no pertenecer a la red a la cual cotizaba. Conclusiones En los servicios de urgencias de Medellín existen barreras de acceso. El acceso inadecuado de acuerdo al tipo y gravedad de la urgencia y la deficiente la articulación de los niveles de atención, soporta la necesidad una red de urgencias en la ciudad.
Objectives Describing access to and availability of emergency medical assistance in Medellín in 2006. Materials and Methods This was a descriptive survey-based study conducted in 27 emergency services from institutions providing tertiary, secondary and primary level health care services carried out over one full week. All patients participating in the survey were followed-up from being admitted to the emergency department to being discharged. The following parameters were described: a patient's characteristics, waiting time, presence of trauma, previous emergency department visit during the previous 48 hours for the same condition, transfer and discharge. The reasons for non-admission were studied in the case of patients who were not admitted by the emergency service. Results 8 703 (89,4 %) out of the 9 730 patients attending the emergency department were then admitted; 13,8 % had visited an emergency department during the previous 48 hours for the same condition and 10,5 % were early transfers. The highest mean waiting time observed for primary level was 40,2 minutes. Reasons for non-admission for the 1 027 non-admitted patients (10,6 %) included hospital staff classifying a case as not being an emergency (62,6 %) and lack of social security service coverage (16 %). Conclusions Barriers were found to emergency service access in Medellín. Inadequate access according to the type of emergency and its seriousness and deficient coordination of attention levels support the need for an emergency network in the city.
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